Summary & Overview
CPT 25607: Open Repair of Distal Radius Fracture with Internal Fixation
CPT code 25607 denotes open reduction and internal fixation of a distal radius fracture. This operative code is used for definitive surgical stabilization of radial fractures that extend beyond the wrist joint or involve separation of the radius from the joint surface. Nationally, the code is important for surgical trauma care, orthopedic service line management, and facility billing for upper-extremity fracture repairs. Key payers typically involved in coverage and reimbursement discussions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find an overview of clinical context for using CPT code 25607, typical sites of service, and the procedural intent of internal fixation to restore alignment and function. The publication summarizes payer coverage considerations and common claim components, outlines relevant benchmarks for utilization and reimbursement, and highlights policy or coding clarifications that affect billing validity. Content is intended to support billing professionals, orthopedic clinicians, and revenue leaders in understanding how this code is applied in practice and what operational factors commonly influence claims and payment.
Billing Code Overview
CPT code 25607 describes the surgical open repair of a fracture of the distal radius (the larger bone of the forearm) beyond the wrist joint or a separation of the distal radius from the joint, using internal fixation such as wires, screws, or pins. This procedure involves making an incision to access the fracture site, anatomically reducing the fracture, and stabilizing the radius with internal hardware to restore alignment and permit healing.
-
Service type: Surgical fracture repair with internal fixation (open reduction and internal fixation of distal radial fracture).
-
Typical site of service: Hospital operating room or ambulatory surgery center, depending on patient stability and complexity of the fracture.
Clinical & Coding Specifications
Clinical Context
A 56-year-old right-hand-dominant patient presents to the emergency department after a fall onto an outstretched hand. Imaging shows an extra-articular distal radius fracture with displacement. The orthopedic surgeon evaluates neurovascular status, documents mechanism, fracture classification, and obtains preoperative consent. The patient is scheduled for open reduction and internal fixation (ORIF) of the distal radius using internal plates, screws, or pins under regional or general anesthesia. Typical workflow includes preoperative anesthesia evaluation, operative fixation in an operating room or ambulatory surgical center, intraoperative fluoroscopic imaging to confirm reduction and hardware placement, immediate post-anesthesia recovery, and postoperative instructions with a splint and outpatient orthopedic follow-up for wound checks and radiographic healing assessment. The typical site of service is the hospital operating room or an ambulatory surgical center for definitive fracture fixation. Common clinical features include pain, swelling, limited wrist motion, and radiographic confirmation of radial displacement or separation from the wrist joint requiring internal fixation to restore anatomy and function.
Coding Specifications
- The table below lists the most clinically relevant modifiers for an open reduction and internal fixation of a distal radius fracture.
| Modifier | Description | When to Use |
|---|---|---|
LT | Left side |